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CASE PRESENTATION
History: This patient is an almost three-yearold girl who presented with a two week history of
ataxia and opsomyoclonus (loss of coordination
and rapid-random eye movements)
Physical exam: Normal. No palpable masses
or lymphadenopathy was appreciated.
Labs: All labs (including CBC & Chem panel)
were within normal limits, except for a low MCV
Imaging: Head CT was done initially, but was
normal. CT of chest, abdomen, and pelvis (with
contrast) was then ordered.
Cross-sectional view slightly below level of
aortic bifurcation
Cross-sectional view two levels below previous image
showing a 2.9 x 3.4 x 3.1 cm mass with calcifications
Differential Dx: For a mass in the para-aortic
region with calcification, must consider
neuroblastoma (66% have calcification) or a
retroperitoneal teratoma. Can consider aortic
aneuryism, but this mass did not enhance with
contrast.
Hospital course: Patient underwent surgical
removal of the mass as well as some pelvic, parailiac, para-caval, and peri-aortic lymph nodes
without any complications.
Pathology: Mass was a neuroblastoma with
unfavorable histology and one positive lymph
node in the para-iliac region. All other nodes were
negative.
Other studies: Bone scan and bone marrow
biopsy to evaluate for other mets were negative.
Treatment: Given that this is at least a stage 2 tumor
with unfavorable histology, treatment involves surgical
removal and chemotherapy. Patient was started on
the standard regimen of cisplatin, etoposide,
doxorubicin, and cyclophosphamide.
References:
Webb WR, Brant WE, Helms C. Fundamentals of Body CT. Second Edition, W.B. Saunders,
Philadelphia, 1998, pg 65-66.
Woodcock RJ, Gay SB. Radiology Recall. First Edition, Lippincott, Philadelphia, 2000, pg
633.
ACR Code: 86.32
Shivam Champaneri, 2004